title: Changing trends in vancomycin-resistant enterococci in French hospitals, 2001-08.
abstract: OBJECTIVE
  Unprecedented outbreaks of vancomycin-resistant enterococci (VRE) have occurred in French hospitals since 2004. The aim of this study was to provide a picture of the spread and control of VRE in France and to characterize the isolates.
  
  
  METHODS
  Notification of VRE cases to Institut de Veille Sanitaire has been mandatory since 2001. Isolates of VRE were sent to the National Reference Centre for species and vancomycin-resistance gene identification. Isolates were tested for antimicrobial susceptibility and typed by PFGE and multilocus sequence typing.
  
  
  RESULTS
  Five hundred and four VRE notifications from 195 hospitals were recorded, corresponding to 2475 cases of infection (n=243) or colonization (n=2232) and 74 episodes of clustered cases. Outbreaks were controlled by implementation of infection control measures, although the number of new hospitals reporting isolation of VRE was increasing. The majority of 902 VRE isolated from 2006 to 2008 were Enterococcus faecium (94.8%) with the vanA or vanB gene. No isolate was resistant to linezolid, tigecycline or fusidic acid. PFGE analysis showed 161 different patterns. Generally a few predominant clones and several minor clones spread in a single hospital. In a subset of 46 representatives of PFGE clones, 13 different sequence types were characterized, all belonging to clonal complex CC17, while the esp and hyl genes were inconsistently detected.
  
  
  CONCLUSIONS
  The national mandatory notification of unusual nosocomial events allowed rapid identification of VRE outbreaks and early implementation of control measures that have proved effective. However, VRE continue to emerge in a growing number of hospitals.
authors.affiliation: Equipe EA2128 Interactions Hôtes et Microorganismes des Epithéliums, Faculté de Médecine de Caen, Université Caen Basse Normandie, 14000 Caen, France.
authors.forename: Nancy
authors.initials: N
authors.lastname: Bourdon
authors.forename: Marguerite
authors.initials: M
authors.lastname: Fines-Guyon
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Thiolet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Maugat
authors.forename: Bruno
authors.initials: B
authors.lastname: Coignard
authors.forename: Roland
authors.initials: R
authors.lastname: Leclercq
authors.forename: Vincent
authors.initials: V
authors.lastname: Cattoir
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005602:France / Q000453:epidemiology; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008565:Membrane Proteins / Q000235:genetics; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D058885:Multilocus Sequence Typing; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D001426:Bacterial Proteins; D008565:Membrane Proteins; C071437:VanA ligase, Bacteria; C079913:VanB protein, Enterococcus; C116707:enterococcal surface protein, esp; D014640:Vancomycin; D019729:Carbon-Oxygen Ligases